Esophagitis associated with alendronate sodium.
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Aged↗
Biomedical subjects
G Valenzuela
Publications and source records attributed to G Valenzuela.
Treatment of preterm labor with the oxytocin antagonist atosiban.
The purpose of this study was to describe the course of preterm labor in patients receiving a standard intravenous infusion of the oxytocin antagonist atosiban. An open-labeled, non-randomized study was conducted at 4 sites. Successful tocolysis was defined as delay of delivery larger than 48 hours from starting atosiban and no need for an alternate tocolytic. Atosiban was administered by continuous intravenous infusion at a rate of 300 micrograms per minute until uterine contractions were absent for 6 hours, or up to a maximum infusion time of 12 hours. Sixty-two patients of between 20 and 36 weeks' gestation were enrolled over 6 months. One had rupture of membranes and was excluded. Successful tocolysis was noted in 43 of 61 (70.5%). Four delivered spontaneously within 48 hours and 14 (23.0%) required an alternate tocolytic agent. The chance of successful tocolysis was related to the degree of cervical dilation at the start of therapy. Cessation of uterine contractions was noted in 38 patients (62.3%). A decrease in uterine contraction frequency of 50% or more was noted in 50 of 61 patients (82.0%). Four patients reported side effects (nausea, vomiting, headache, dysguesia, chest pain), but in no case did side effects require discontinuation of the medication. Intravenous administration of atosiban is associated with a delay in delivery comparable to that seen with other tocolytics. If this effect is confirmed in planned placebo-controlled trials, its favorable side effect profile may give it a place in the armamentarium.
Adult↗
Day-night changes in c-fos expression in the fetal sheep suprachiasmatic nucleus at late gestation.
The suprachiasmatic nucleus (SCN) is a circadian oscillator in mammals and shows day-night changes in metabolic activity. To investigate whether the fetal sheep SCN behaves as a circadian oscillator, day-night changes in c-fos expression, a marker of neuronal activity, were measured. Eight fetal sheep were sacrificed at 135 days gestation--four at day-time (1200 hours) and four at night-time (2400 hours). Fetal brains were fixed, removed and cut in 40-microns serial coronal sections. Alternate sections were incubated with anti-Fos antibody (1:500) and Fos expression was revealed with extra-avidin-peroxidase and 3,3'-diaminobenzidine or stained with cresyl violet. The number of Fos-immunoreactive (Fos-ir) neurons per mm2 in the rostral, intermediate and caudal regions of the fetal sheep SCN was counted. Fetuses sacrificed in the day-time showed a higher number of Fos-ir neurons per mm2 (mean +/- s.e.; 516.7 +/- 60.1) in the three regions of the SCN than fetuses sacrificed at night-time (140.5 +/- 21.8). In addition, at night-time Fos-ir neurons were mainly localized to the ventrolateral area of the SCN. These findings demonstrate day-night changes in molecular activity consistent with the presence of a circadian oscillator in the fetal sheep SCN.
Animals↗
Waardenburg syndrome and gastric stasis in adults.
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Adult↗
[Prevention of surgical wound infections after appendectomy: intravenous versus rectal metronidazole].
AIM: To compare the efficacy of rectal and intravenous metronidazole in the prevention of anaerobic wound infections after appendicectomy. PATIENTS AND METHODS: One hundred patients subjected to appendicectomy were randomly assigned to receive, 2 hours before operation, gentamycin 80 mg i.v. and metronidazole 1 g i.v. or the same amount of gentamycin and 1 g of metronidazole as a suppository. Surgical wounds were observed for infections until the tenth day of the postoperative period. RESULTS: Seven of 45 patients receiving intravenous metronidazole and six of 44 receiving the drug as suppositories had wound infection. The frequency of infections was higher among patients with gangrenous or perforated appendices. They were detected at the fifth postoperative day in 8 patients and the most frequently isolated bacteria were E coli and S aureus. CONCLUSIONS: Rectal metronidazole is equally effective than intravenous metronidazole in the prevention of would infections after appendicectomy.
Administration, Rectal↗
The effect of the oxytocin antagonist atosiban on preterm uterine activity in the human.
OBJECTIVE: The purpose of this study was to test the hypothesis that infusion of the oxytocin antagonist atosiban results in decreased preterm uterine activity in the human. STUDY DESIGN: A randomized, double-blind, placebo-controlled trial was performed. One hundred twenty women from 20 to 36 weeks' gestation with a complaint of labor who had more than four uterine contractions per hour after intravenous hydration but no evidence of cervical changes were randomized to receive a 2-hour intravenous infusion of atosiban at a rate of 300 micrograms/min or placebo. Ond hundred-twelve subjects (56 in each arm) were suitable for analysis of efficacy. Both groups remained at bed rest and received hydration. RESULTS: The mean percent decrease in contraction frequency was greater in atosiban subjects compared with controls (55.3% +/- 36.3% vs 26.7% +/- 40.4%, mean +/- SD, p < 0.001). A minimal (< 20%) decrease or an increase in contraction frequency was noted in 25 placebo subjects (45%) and seven atosiban subjects (13%). There was no clinically or statistically significant change in maternal blood pressure or heart rate during the infusion. The only adverse experiences possibly related to the drug were nausea and vomiting in one atosiban patient. CONCLUSION: A 2-hour infusion of the oxytocin antagonist atosiban resulted in a significantly greater decline in contraction frequency compared with controls. Oxytocin appears to play a role in the maintenance of preterm uterine activity in the human.
Adult↗
Integrating developmentally supportive caregiving into practice through education.
Implementation of developmental caregiving is occurring in intensive care nurseries across the country. Sound theories of adult learning, program planning, and change principles must be utilized to guide this process and to provide a framework for program design. If leaders and change agents are aware of these concepts and use them to make the process easier, integration should be less painful and the concepts promptly instituted into routine practices. Neonatal Individualized Developmental Care and Assessment Program research has demonstrated positive outcomes. This research has provided us with a vision to guide our practice, but change theory and education of staff also need to be addressed in this process.
Education, Nursing, Continuing↗
Prenatal development of the retinohypothalamic pathway and the suprachiasmatic nucleus in the sheep.
Circadian rhythms are present during fetal life in several mammalian species. To characterize the ontogeny of the neural mechanisms that account for circadian rhythmicity in a precocious species, we studied the prenatal development of the retinohypothalamic pathway in lambs (gestation period of 147 days), using horseradish peroxidase and wheat germ agglutinin as anterograde tracers. The suprachiasmatic nucleus was present as early as embryonic day 52 (E52). After E58, the suprachiasmatic nucleus reached its full number of neurons, estimated by the disector method in about 160,000 cells per nucleus at E62. The retinohypothalamic axons invaded the suprachiasmatic nucleus from E58, while neuroblasts were still migrating to the nucleus. At E62, there was a strong retinal projection that evolved until E121, when the retinal afferents established their definitive pattern of distribution in the ventral and central regions of the suprachiasmatic nucleus, and adjacent hypothalamic structures. The development of the retinohypothalamic pathway was delayed by about a week relative to the innervation of other subcortical visual centers. The present findings demonstrated an early prenatal development of the visual pathways in lambs, including the retinohypothalamic pathway, suggesting that the mechanisms for the visual entrainment of circadian rhythms in lambs may be functioning several weeks before birth.
Animals↗
Esophageal perforation. A reassessment of the criteria for choosing medical or surgical therapy.
Treatment for esophageal perforation has traditionally been surgery, but development of more effective antibiotics and parenteral nutrition has led to a cautious trend toward nonoperative management. The goal of this investigation was to identify relevant presenting features that would guide a physician in making the therapeutic choice between medical and surgical therapy. Twenty-five consecutive patients with esophageal perforation--20 iatrogenic and five spontaneous--were reviewed. Treatment was medical in 12 cases and surgical in 13. The findings indicate that many patients with esophageal perforation can be treated medically. The following guidelines are suggested for selecting nonoperative treatment: (1) clinically stable patients; (2) instrumental perforations detected before major mediastinal contamination has occurred or perforations with such a long delay in diagnosis that the patient has already demonstrated tolerance for the perforation without the need for surgery; and (3) esophageal disruptions well contained within the mediastinum or a pleural loculus.
Adult↗
The retino-hypothalamic tract is involved in prolactin regulation in fetal sheep.
To investigate the role of the retino-hypothalamic tract on fetal prolactin regulation, we examined the effect of ocular enucleation on fetal plasma prolactin. Eleven fetuses of Suffolk ewes were chronically catheterized during fall, and six of them were subjected to bilateral ocular enucleation. All ewes were kept at 12h:12h light:dark cycle (lights on at 0800 and off at 2000). The experiments were performed 5-9 days after surgery (GA control fetuses 125 +/- 1.5, optical enucleation 121.3 +/- 1.5 days). Blood samples were taken from fetuses hourly around the clock, and plasma prolactin and cortisol were measured by radioimmunoassay (RIA). Luteinizing hormone (LH) and Growth hormone (GH) were measured in pooled plasma samples from control and enucleated fetuses by RIA. Average plasma prolactin was 5-fold lower in enucleated than in control fetuses (9.6 +/- 0.5 and 54.2 +/- 3.3 ng/ml, SEM; P < 0.005). Both control and enucleated fetuses presented circadian rhythm of prolactin with acrophase between 1400 and 1830 h. An enucleated fetus was tested for response of prolactin to TRH. Prolactin increased as described in the literature. There was no change in plasma concentration of cortisol, LH or GH after ocular enucleation. Our data indicate that the optical pathway participates in prolactin regulation in the fetal sheep.
Animals↗
Report different results in esophageal perforation patients.
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Esophageal Perforation↗
Subcutaneous metoclopramide in the treatment of symptomatic gastroparesis: clinical efficacy and pharmacokinetics.
We investigated the safety and efficacy of short-term s.c. administration of metoclopramide in the treatment of symptomatic gastric stasis. Ten patients with gastroparesis, documented by abnormal solid phase radionuclide gastric emptying study, were treated with 10 mg (2 ml) of s.c. metoclopramide every 6 hr for 3 days. Patients gave themselves the injections as outpatients. Questionnaires were then completed concerning symptom relief, local side effects and adverse reactions. A repeat gastric emptying study was obtained immediately after the last dose of metoclopramide. Serum metoclopramide concentrations were obtained at trough, 1, 2, 3, 4 and 5 hr postadministration and serum prolactin levels at trough, 1 and 3 hr. Pharmacokinetic analysis showed mean peak metoclopramide concentration at 30 min of 99.7 +/- 47.1 ng/ml with measured levels of 93.9 +/- 106.83 ng/ml at 60 min and return to trough values by 4 hr; trough prolactins remained elevated above normal values. Gastric stasis improved from a base-line retention of 78.7% of radioisotope at 2 hr to 72.5% after 3 days of therapy (P = .65). Eight patients reported significant improvement in symptomology and two patients reported lessening of symptoms such as nausea, vomiting, bloating, abdominal pain, heartburn and vomiting. The side effects were minimal and did not interfere with completion of the protocol. We demonstrated that s.c. administration of metoclopramide was well accepted by patients and resulted in subjective and objective improvement of gastric stasis. In addition, serum metoclopramide concentrations were comparable with other parenteral routes of administration. Furthermore, serum prolactin levels may provide both a bioassay of efficacy and a marker for monitoring compliance.
Adult↗
Primary adrenal insufficiency: a new cause of reversible gastric stasis.
Primary adrenal insufficiency is known to cause a wide spectrum of sometimes severe upper gastrointestinal symptoms; however, it has not previously been shown to be the cause of reversible gastric stasis. We have documented such a case in which the symptoms and physiologic abnormalities associated with gastric stasis were reversed by steroid replacement. A follow-up radionuclide gastric-emptying study after physiologic steroid replacement showed complete normalization of gastric emptying. Although gastric stasis has long been suspected of being present with primary adrenal insufficiency, this represents the first case in which it has been documented, and so should be included in the differential diagnosis of patients presenting with chronic nausea and vomiting.
Adrenal Cortex Diseases↗
Plasma atrial natriuretic peptide levels during the rat estrous cycle, pregnancy, and puerperium.
The rat has been used as a model for studying the changes that occur in maternal blood volume and renal function during pregnancy. The role, if any, that atrial natriuretic peptide plays in regulating these changes is unknown, and little information is available on atrial natriuretic peptide levels at different stages of gestation in the rat. In this study we measured plasma atrial natriuretic peptide levels by radioimmunoassay in the rat at each stage of the estrous cycle, during the last 2 weeks of pregnancy, and in the early postpartum period. Atrial natriuretic peptide levels did not change during the estrous cycle. Atrial natriuretic peptide levels were low on days 10 to 15 of gestation but rose to become significantly higher than nonpregnant levels on days 16 to 18. On day 21 shortly before delivery, levels were similar to nonpregnant values. Postpartum, atrial natriuretic peptide levels rose immediately and remained elevated for the next 48 hours. These findings suggest that factors other than blood volume may mediate plasma atrial natriuretic peptide levels during pregnancy and the postpartum period.
Animals↗
Gonadotropin-releasing hormone effects on placental hormones during gestation: I. Alpha-human chorionic gonadotropin, human chorionic gonadotropin and human chorionic somatomammotropin.
The release of alpha-human chorionic gonadotropin (alpha hCG), gonadotropin human chorionic gonadotropin (hCG) and human chorionic somatomammotropin (hCS) in vitro from placentas of different gestational ages was studied. In addition, the effect of gonadotropin-releasing hormone (GnRH) on these hormonal releases, as related to the gestational age of the placenta cultured and the dose of GnRH, was determined. The basal release of alpha hCG and hCG was greatest at 9-13 wk of gestation (1000-1500 ng/mg and 250-350 ng/mg, respectively). Lowest release rates were at term (28 ng/mg and 20 ng/mg, respectively). Hormonal release declined with extended culture, except from the cultures of 13- and 15-wk placentas, in which the initially high release continued throughout the 8 days of culture. The initial release of hCS was low at 6 wk, increased to maximum rates by 15 wk, and was similar to the initial rate of release at term. Gonadotropin-releasing hormone stimulated the release of alpha hCG and hCG most dramatically in cultures of 16-wk and 17-wk placentas, where as much as a 400- and 250-fold increase, respectively, on Day 6 of culture was observed (p less than 0.0001). In term placenta cultures after 6 days in vitro, a 20-fold stimulation of alpha hCG and a 10-fold increase of hCG was effected by GnRH (p less than 0.001). The largest responses of alpha hCG and hCG to GnRH were observed when estrogen levels were low. Dose-related responses were observed in some placentas, yet in some instances, maximal effects were attained with all doses utilized in these studies (0.2 to 50 micrograms/ml). These data demonstrate that human placentas of different gestational ages have varying hormonogenic capabilities in vitro. The data also establish that synthetic GnRH is capable of stimulating alpha hCG and hCG production, but the degree and pattern of response to GnRH stimulation are related to the gestational age of the placental tissue and its time in culture. The most responsive period to exogenous GnRH stimulation of alpha hCG and hCG release was on Days 5 and 6 of culture, when basal estrogen release was very low. These data support the hypothesis that hCG release might be controlled by a chorionic GnRH stimulation and suggest that local steroid levels may modulate the hCG response to GnRH stimulation.
Chorionic Gonadotropin↗
Gonadotropin-releasing hormone effects on placental hormones during gestation: II. Progesterone, estrone, estradiol and estriol.
The release of progesterone (P), estrone (E1), estradiol (E2) and estriol (E3) from human placental tissue in vitro was found to be related to the gestational age of the placenta. The basal release of P, E1 and E2 on Day 1 of culture was highest from placentas of early gestation (9-13 wk). The release of P then declined, reaching a nadir by 15 wk, and continued at that level. The release of E1 and E2, reached a nadir at 17 weeks, and then again increased by term. In contrast, the basal release of E3 increased with increasing gestational age of the placenta. Thus, it appears that differing factors may influence placental P, E1, E2 and E3 production. In addition, the effect of synthetic gonadotropin-releasing hormone (GnRH) on these hormonal releases was studied. The stimulation of P by GnRH was greatest in placentas of 16 and 17 wk of gestation after extended culture when the basal release of P had declined. As much as a 240-fold increase was observed on the eighth day of culture. A large stimulation of P (32-fold) was also observed in the term placental cultures. A stimulation of E1 and E2 by GnRH was observed during the initial days of culture and in mid-gestational placental cultures (16-17 wk). A stimulation of E2 only was also observed at 13-15 wk and at term. A stimulation of E3 was observed in certain individual placentas. A correlation of the P and human chorionic gonadotropin (hCG) response to GnRH stimulation was noted, as well as an inverse relation of estrogens and hCG stimulation by GnRH. These data demonstrate that steroidogenic competence of the placenta differs with gestational age and that GnRH can influence steroid release. The degree and pattern of response to GnRH varied with the gestational age of the placenta and its endocrine milieu.
Estradiol↗
GnRH effects on placental hormones during gestation. III. Prostaglandin E, prostaglandin F, and 13,14-dihydro-15-keto-prostaglandin F.
We studied the release of prostaglandin E (PGE), prostaglandin F (PGF) and 13,14-dihydro-15-keto-prostaglandin F (MPF) from explants of human placentas of different gestational ages and the effect of gonadotropin-releasing hormone (GnRH) on this release. The greatest basal release of PGE, PGF and MPF was in the cultures from 9- to 13-wk placentas, with the release on the second and third days of culture increasing 4- to 10-fold from that of the first day. In cultures from 15-wk to term placentas, the initial basal release (Day 1) of these prostaglandins was only slightly higher than in cultures from 6-wk placentas. In cultures from term placentas, the later increase with extended culture was absent or very small. Addition of synthetic GnRH to the cultures from 6- to 9-wk placentas effected no significant change in release of PGE, PGF or MPF. However, GnRH added to the cultures from 13-wk placentas effected a dose-related inhibition of these prostaglandins. After 15 wk, we observed a stimulation of these prostaglandins by GnRH that was as much as 50-fold; stimulation was highly significant in the cultures from 16- and 17-wk, as well as in those from the term placentas. These data demonstrate an action of GnRH on prostaglandin release and indicate that both the basal release of PGE, PGF and MPF and the response to GnRH are related to the gestational age of the placenta.
Dinoprost↗
Thoracic duct lymph flow in pregnant sheep and response to blood volume expansion.
Left thoracic duct lymph flow rate averaged 0.077 +/- 0.003 (SD) and 0.078 +/- 0.003 ml X min-1 X kg-1 in near-term pregnant and nonpregnant sheep (P greater than 0.5). Lymph and plasma protein concentrations were unaltered in the pregnant compared with the nonpregnant animals. The thoracic duct lymph flow responses to three serial intravenous infusions of lactated Ringer solution were essentially the same in the pregnant and nonpregnant animals. Blood volume and vascular pressure changes during and after volume loading were essentially the same in both groups. In addition, terbutaline administration after volume loading caused no change in thoracic duct lymph flow rates. Thus the present study suggests that basal lymph flow rates, lymphatic function, and vascular as well as interstitial compliances are largely unaltered late in pregnancy in the sheep. In addition, beta-mimetic stimulation with terbutaline does not appear to suppress lymph flow rate.
Animals↗